Rural career choice issues as reported by first year medical students and rural general practitioners.

Governments have recently instituted several programmes designed to attract medical students to rural practice. Questions may be raised as to whether interventions based around issues identified as important to practising rural general practitioners (GPs) are equally applicable to undergraduate medical students. The results of two studies on the importance of personal and practice issues as ascribed by Australian rural GPs and Victorian medical students are analysed. The effect of the students' gender, place of origin and intended location of practice is assessed. Findings suggest that practising GPs may have resolved many of the student issues and may be well placed to advise students on perceived hurdles to rural practice. Furthermore, students may be seeking a practice style similar to that sought by female GPs. The present paper concludes that while there are similarities between the groups, the differences identified support caution when basing student programmes on research performed on rural GPs.

General practitioner preparedness to respond to a medical disaster. Part I: Skills and equipment.

OBJECTIVE: Financial constraints are leading to the downgrading or closure of many country hospitals throughout Australia. There is concern that general practitioners (GPs) could become deskilled if they lose access to a local hospital. A recent survey of Victorian rural GPs showed that rural GPs in towns without hospitals had different characteristics and working conditions from those with hospital access and backup. Campbell uncovered an apparent paradox: GPs without hospitals were more likely to have emergencies brought directly to their surgeries, and had more equipment in their surgeries, yet they had significantly lower confidence in emergency skills. METHOD: A questionnaire was sent to 100 general practitioners in two rural divisions of general practice in Victoria, Australia. They were asked to indicate their confidence in performing 18 emergency procedures. They were also asked whether they had available the necessary equipment. RESULTS: We have assessed the availability of GP emergency skills and equipment in two rural divisions of general practice--one with, the other without, local hospitals. The division without hospitals scored significantly lower in skill levels. A close correlation was found between skill levels and equipment availability. There has been a significant reduction in skill levels in both divisions over time. CONCLUSION: The skills necessary for the stabilisation of a single patient with a life threatening condition are not dissimilar from those needed to treat such a patient in a multiple victim scenario, although the approach and external pressures may be different. These skills, then, are essential to all general practice. The information sought in this survey would be important in the assessment of GP preparedness for both single-victim and multiple-victim (disaster) emergencies. The results of this study raise doubts as to the ability of at least one division to respond to a disaster.

General practitioner preparedness to respond to a medical disaster. Part II: Ability and training.

OBJECTIVE: Part I of this paper looked at the availability of 18 individual skills in two rural Victorian divisions of general practice, one with hospitals, and the other without. It looked at the deskilling of rural general practitioners and highlights a direct relationship between skill and equipment availability, and in particular, the effect of a local hospital. METHOD: By analysing the data in Part I, this paper looks at the availability of rural GPs with the ability to perform a range of 15 pre-hospital skills and analyses the effect of retraining in selected skills. RESULTS: Part I identified needle and surgical cricothyrotomy as weaknesses requiring retraining in both divisions. Refreshing these led to a modest improvement only. In addition to the cricothyrotomies, retraining in one skill (as chosen by the GP), will increase to over 50% in both divisions, the percentage of GPs with the first nine skills only. CONCLUSIONS: We found that neither division currently has adequate numbers of GPs with the required range of skills to allow for a GP based response to a disaster. Retraining the GP in both the cricothyrotomies and two self-nominated weakest skills resulted in adequate numbers of skilled GPs. The former can be provided by mass training and the latter requires a more personalized training. A 'travelling circus' format is described as a suitable means for this retraining. It also improves networking among health professionals likely to be involved in a disaster, and offers infrastructure support for GP involvement in emergency management, a public education vehicle, and a research vehicle for the study of critical and emergency care to rural areas.

GP-based emergency response in rural areas: is there a need?

Rural general practitioners (GPs) traditionally provide the initial care for the very ill and severely traumatised in small and medium-sized rural hospitals. It has been said that these patients would be better managed in a level 1 trauma centre. The present paper will test this hypothesis and shows that the benefits of the expertise available in the large centres may be outweighed by the loss of life in the prehospital phase, most of which occurs before the arrival of the ambulance. General practitioner involvement would enhance the current early retrieval system. Very ill and severe trauma should be assessed and stabilised in the most appropriate local facility. Routine bypassing of local emergency medical services should be avoided. A national standard for training rural GPs in emergency management skills is needed. Emergency facilities and equipment must be maintained and improved throughout rural Australia. These facilities and their staff must be accredited so that the ambulance service can more appropriately determine its transport priorities.

The GP as first responder in a major medical emergency.

UNLABELLED: While there have been many articles and seminars on the Ash Wednesday bushfire and Port Arthur shooting disasters, the role, responsibility and support structure of general practitioners (GPs) and the effect of the disaster on them, have received little attention. This paper looks at the role of the GP as the first responder in a disaster in rural and semi-rural Australia. Hopefully, a structured involvement, with adequate preparation and recovery, will minimise harm to these respondents. This article was written after a local GP response to disasters had been incorporated into the local Displan of one region. This response was successfully activated by Victorian State Displan during the Dandenong Ranges bushfire disaster of January, 1997. DEFINITIONS: A disaster is said to have occurred when normal community and organisational arrangements are overwhelmed by an event, and extraordinary responses need to be instituted. First responder has become the generic term for those who arrive at the scene during the early phase of the response, that is, before centralised coordination is in place. Displan is the abbreviation for the State Emergency Response Plan. The phases of emergency management consist of: prevention; preparation; response; and recovery.